Minor Obstetric surgeries Flashcards
Elective surgical abortion
1st trimester
- Dilation and curettage= scrapes the endometrial tissue using a curette
- Aspiration abortion is used during the first trimester
Elective surgical abortion
2nd trimester
- Dilation and evacuation= A gynecological procedure that involves dilating the cervix (manually or pharmacologically)
Suctioning the amniotic fluid, and physically removing products of conception, typically with forceps. Referred to as intact dilation and evacuation when the fetus is removed in one piece. Commonly performed after 13 weeks’ gestation for induced procedural abortion or fetal demise. Prophylactic antibiotics decrease the risk of infection.
Elective surgical abortion: drugs used to ripen the cervix or methods to dilate ?
- Medication= prostaglandin analog (misoprostol)
- Osmotic dilators= placed into cervix, draws water from surrounding then swells allowing view into the cervix (hygyroscopic material in a stick)
Caesarean section: types
- Lowers segment = suprapubic transverse incision (2 cuts: Pfannenstiel incision aka curved, or Joel-Cohen incision)
- Classical= vertical incision
The Lower segment allows for trial of labour in subsequent pregnancies
Caesarean section: indication
- Foetal/maternal health compromised=foetal distress, placenta praevia, abnormal lie,
- Emergency= distress, prolonged first stage of labour >12hrs, uterine rupture
- Elective= pre-eclampsia
Caesarean section: advantages vs disadvantages
- Advantage= safe for baby, and best option if maternal or foetal health is compromised
- Disadvantage= long recovery process, post op complications
Caesarean section: contraindication
No true contraindications
Caesarean section: basic steps
- Skin incision above the pubic symphysis.
- Largely blunt penetration through the abdominal muscles, fascia, and peritoneum
- Hysterotomy
- Fetal extraction, cord clamping, and manual placental removal
- Wound closure
Caesarean section: complications
- Maternal= infection, haemorrhage, iatrogenic damage to bladder or other ogans, pain
- Foetal= Postnatal transient tachypnea of the newborn, Acute respiratory distress syndrome
Oulet forceps: what does this mean?
Outlet forceps are used when the babies head is on the pelvic floor
Outlet forceps: types
Simpson and Wrigley
Vacuum extraction delivery: indication
- Prolonged 2nd stage of labour
- Nonreassuring foetal heart rate
- Maternal fatigue
Vacuum extration delivery: where does the cup go on the foetal head?
Sagittal suture at the median flexion point (also known as the pivot point), which is 2 cm anterior to the posterior fontanelle or 6 cm posterior to the anterior fontanelle.
Vacuum extraction delivery: contraindication
- Breech or face presentation
- Intracranial haemorrhage
Vacuum extraction delivery: foetal complications
- ‘Chignon’, a swelling of the area of scalp that was drawn into the cup
- Scalp laceration
- Cephalohaematoma
Vacuum extraction delivery: maternal complication
- Suction of maternal soft tissue
- Lacerations
ECV: when do you attempt?
- 37 weeks, attempt ECV
- Make sure there is no contraindications such as placenta praevia
ECV: method
- Empty bladder
- Give tocolysis ?
- Attempt to rotation in direction of flexion
Internal version: method
- Apply spinal anaesthetic
- Use aspetic method (sterile gloves and iodine)
- Insert hand into the vagina to the cervix and once at the opening to the uterus, feel for the leg and pull
- Deliver in breech
- Check for placenta etc after delivery and give abx
High risk of uterine rupture, infection etc
Vaginal breech: Tzovyanov, Bracht, Mueller, Lovset
- Tzovyanov=frank breech. Same as Bracht
- Bracht= frank breech. Allowed to delivery until the umbilicus spontaneously. Grasp the body and keep legs extended by placing thumbs on either thigh and fingers on the back. Then slowly bring that delivered portion to the mother abdomen whilst assisst applies suprapubic pressure.
- Muller= helps delivery the shoulder, so hold hips rotate slightly and pull down, deliver the anterior shoulder then pull upwards to deliver the posterior
- Lovset= hold the sacroiliac joint and rotate the back half circle to delivery the impacted shoulder then the opposite direction. Keep downward traction. Posterior arm deliver first
No traction, just holding in 1&2. Keep hands off basically as much
ECV: contraindication
- Placenta praevia
- Twin pregnancy
- Scarred uterus
- Prematurity
Breech vaginal delivery: the cardinal movements
- Engagement
- Decent
- Internal rotation of the anterior buttocks
- Lateral flexion
- Delivery of trunk
- Restitution
- engagement and descent of shoulder
- Internal rotation of shoulder
- Lateral flexion
- Delivery of shoulder
- then delivery of the head
Braxton-Hicks version: what happens?
- Basically you combine internal version with external version
- Use need: sufficent mobile uterus, enough dilation and
